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A 13 year-old boy is having a bloody diarrhea 5 times a day for 2 days.

He vomits 3
times. He felt pain in his anus while he passes his stool. He also has fever
What mechanism occur in his bowel when passing the stool?
A. Longitudinal muscle relaxation in receiving segment
B. Circular muscle contraction in receiving segment
C. Longitudinal muscle contraction in propulsive segment
D. Circular muscle contraction in propulsive segment D
E. Circular muscle relaxation in propulsive segment

A 34-year-old woman has the sudden onset of severe abdominal pain. On physical
examination she is afebrile. The pain is centered in the mid-epigastric region, though
there is marked diffuse tenderness in all quadrants. Laboratory studies show her serum
amylase is 410 U/L and lipase is 610 U/L. Which of the following laboratory test findings
is most likely to be present in this woman?
A Hypoproteinemia
B Positive urea breath test
C Hyperglycemia C
D Elevated sweat chloride
E Positive serology for HBsAg

A 31-year-old woman has a 10 year history of intermittent, bloody diarrhea. She has no
other major medical problems. On physical examination there are no lesions palpable on
digital rectal examination, but a stool sample is positive for occult blood
This patient is at greatest risk for development of which of the following conditions?
A Pancreatitis
B Diverticulitis
C Cholangitis B
D Appendicitis
E Perirectal fistula

A 32 year old woman comes to the emergency room with severe epigastric and right
upper quadrant pain 3 hours after eating gulai in Minang restaurant. The pain
occasionally radiates to her right flank and right back. She has slight fever and her
abdomen is tender to palpation in the right upper quadrant. Her lab tests are as follows:
ALT: 44 U/l (<30 )
AST: 25 U/l (<30 )
Total bilirubin: 1,3 mg/dl (0-1)
Alkaline phosphatase: 100 U/l (38-126)
White blood 14500 (6000-10000)
Amylase: 67 U/l (53-123)
Lipase: 55 U/l (10-150)

What is the most likely explanation for this patient’s symptoms?


A. Acute cholecystitis
B. Acute peptic ulcer
C. Acute pancreatitis A
D. Acute appendicitis
E. Acute hepatitis B

Adi was a 25-year-old male who complained of pain, nausea with vomiting, and
tenderness in the right lower quadrant. The pain was first vague and diffuse, and then
became more severe in the epigastric region before localizing in the right lower quadrant.
The pain was getting worse with movement, coughing, or sneezing.. His vital sign were:
BP 140/90, Pulse 96x/min, RR 18x/min, Temperature 38.2°C. A marked tenderness was
found on the right lower quadrant , particularly when pressed and released. There was a
decreased of bowel sounds.

What is the most suitable next step management for this patient?
A. Abdominal X-ray
B. Complete Blood count
C. Insert Nasogastric tube B
D. Establish an intravenousline
E. Prepare immediate operation

A 52-year-old man with peptic ulcer disease has been on drug therapy for 3
months. While on this regimen, he noticed changes in his bowel habits,
increasing headaches, dizziness, skin rashes, loss of libido, and gynecomastia.
Which drug is the most likely responsible for these effects?
cimetidine
famotidine
misoprostol
omeprazole
ranitidine

1. A 62-year-old man with chief complain nausea,vomiting, and epigastric pain.


He was given stomach medication, three hour later, he had dyskinesia and
rigidity (extra pyramidal symptoms). Which of the following drug is the most
appropriate that can cause this situation?
A. domperidone
B. metoclopramide
C. ondansetrone
D. omeprazole
E. sucralfate

2. A 48-year-old man presents with a complaint of chronic no bloody diarrhea


and right lower quadrant pain with a palpable mass and tenderness. He
states that this "flare-up" is one of the worst he has ever experienced.
Radiographic exam reveals evidence of ulceration, stricturing, and fistula
development of the colon and small bowel.
Which of the following drugs would be the most appropriate for treating this
patient?
A. Diphenoxylate
B. Loperamide
C. Hyoscyamine
D. Mesalamine
E. Prednisone

3. A 70-year-old man with a history of atrial fibrillation is started on an oral


anticoagulant. His prothrombin time is monitored on a regular basis. A few
months into his therapy, he begins treatment for a duodenal ulcer and he
develops symptoms of a bleeding diathesis. Which of the following ulcer
medications is most likely responsible for this change in his hemostatic
status?
A. Cimetidine
B. Famotidine
C. Misoprostol
D. Rabeprazole
E. Ranitidine

4. A 51-year-old man comes to your private practice with a history of mid


epigastric upper abdominal pain that diminished by eating or taking antacid
tables. He drinks 2-3 glasses of beer every night, also taking 2-3 tablets of
aspirin frequently for his stress related headache. PE reveals no evidence for
blood in the stool. You advised him to replace the aspirin with acetaminophen
and stop his drinking of beer; you give him a prescription of famotidine 20 mg
bid. Which of the following is the mechanism of action of famotidine?
A. Eradication of H.pylori
B. Increase of motility
C. Inhibit acid secretion
D. Neutralized gastric acid
E. Protect gastric mucous

5. A 48-year-old woman recently diagnosed with an adenocarcinoma. The


oncologist schedules her for radiation and chemotherapy. Because nausea
and vomiting are common complications, you recommend antiemetic
premedication with dexamethasone. Which of the following antiemetic drugs
would be the most appropriate for this condition?
A. Chlorpromazine
B. Dimenhydrinate
C. Ondansetron
D. Prometazine
E. Scopolamine

6. A 24 year old woman comes to your private practice because of experiencing


heartburn after meals, especially when reclining on her sectional at home.
Her symptoms are typically relieved by antacids. In addition to an H2 blockers
or PPI drugs, what additional agent could help treat her esophagitis by
coating necrotic tissue with a protective barrier, and thereby promote healing
of the ulcer?
A. Attapulgite
B. Calcium carbonate
C. Loperamide
D. Mg-Al hydroxide
E. Sucralfate

7. A 18-year-old man presents with intermittent cramp abdominal pain, no


bloody diarrhea, and weight loss of 5 kg over 6 months. The diarrhea, wake
him from sleep. On a few occasions, he has had fevers, nausea, and
vomiting. The patient describes his work as being stressful. PE: normal vital
signs. He has an oral aphthous ulcer (sariawan) and poorly localized lower
abdominal to mid abdominal tenderness without peritoneal signs. Anal and
rectal examinations are normal, and a stool guaiac test (for detecting occult
blood) is negative. Stool leukocytes are present. The Hb 11.5 and Ht is 34%.
Results of sigmoidoscopy are normal. Which of the following is the most
likely diagnosis for this patient?
A. Acute appendicitis
B. Crohn disease
C. Colon cancer
D. Irritable bowel syndrome
E. Ulcerative colitis

8. A 52-year-old man with a history of poorly controlled diabetes mellitus


presents to the emergency department with severe abdominal pain of 36
hours’ duration. He had no fever, some times drink ½ glass of beer. A similar
episode 4 months ago. PE: tachycardia, diminished bowel sounds, epigastric
tenderness, and a papular rash on his knees. Laboratory studies are
significant for the following: leukocytes, 15,000 cells/mm3; blood glucose
level, 450 mg/dl; amylase level slightly increased. Which of the following is
the most likely diagnosis?
A. Acute on chronic pancreatitis
B. Pancreatitis due to gallstone
C. Pancreatitis due to alcohol
D. Pancreatitis due to infection
E. Pancreatitis due to hypertriglyceridemia

9. A 50-year-old man comes to your clinic complaining of acute severe upper


abdominal pain that radiates to his back and worsens with meals. He has a
long history of binge drinking. He notes that lately he has been losing weight
and that his stools have been loose. Physical examination reveals positive
Murphy’s sign. Which of the following should be the first test to determine the
patient problem?
A. Rontgent plain film
B. Ultrasonography
C. CT scan
D. ERCP
E. Secretin test

10. A 35-year-old man comes with yellowish color in his skin. He feels fine, his
medical history is unremarkable, and he takes no medications. Lately, he has
noted dark urine and pale stools. The patient’s vital signs are normal, but he
is clearly jaundiced. His abdomen is nontender and no organomegaly.
Complete blood count and electrolyte and amylase levels are normal. An
abdominal ultrasound shows multiple small gallstones in the gallbladder but
none in the common bile duct. The common bile duct, however, is dilated.
Which of the following should be the next step in diagnosing this patient?
A. CT
B. ERCP
C. Transhepatic cholangiography
D. Repeat ultrasound
E. Cholescintigraphy

11. A 38-year-old man with debilitating Crohn disease who has undergone a 40
cm ileal resection presents for evaluation. He has progressive non-bloody
diarrhea since his surgery 9 months ago, which is worse in the evening. He
denies having abdominal pain, nausea or vomiting, fevers, chills, or sweats.
He reports no recent travel, camping, or use of antibiotics. The physical
examination is unremarkable. Chemistries show modest hypokalemia and a
mild non–anion gap acidosis. Fecal fat quantitative analysis reveals minimal
steatorrhea.. Which therapy is most likely to help this patient?
A. Loperamide
B. Cholestyramine
C. Probiotics
D. High-protein, low-fat diet
E. Somatostatin

Which of the following is the underlying mechanism of the diarrhea?


a. Malabsorption
b. Hypermotility
c. Hypersecretion
d. Normal flora disturbance
e. Hyperosmolarity

1. Mrs. Kartini, an Indonesian 30 year-old-lady, came to Puskesmas because she


became fatigue easily and felt unwell since a month ago. She was found compos
mentis with normal vital signs. Body weight: 50 kg, body height: 150 cm.

Based on her body mass index calculation, her nutritional status was determined
in what classification?untuk endokrin
a. underweight
b. normal range
c. pre-obese
d. overweight
e. obese I
Key: B

2. If then Mrs. Kartini was diagnosed as a medical patient but did not need to be
hospitalised, how much was her energy requirement?
A. 1000 kcal
B. 1230 kcal
C. 1530 kcal
D. 2000 kcal
E. 2230 kcal
Key: C

3. In terms of macronutrient requirement, how much calorie did Mrs. Kartini need for
carbohydrates?
A. 15-20 % of her total energy requirement
B. 25-30 % of her total energy requirement
C. 35-40% of her total energy requirement
D. 45-50% of her total energy requirement
E. 55-60% of her total energy requirement
Key: E

4. Meri, a 3 year old girl, came to the Puskesmas with ulcer on her left leg. Through the
history taking it was revealed that Meri had not been well fed in this past year since her
father lost his job. From her physical examination it was found that her BMI (body mass
index) was below -2 SD (standard deviation) for girls of her age. She was fully alert but
looked pale with a face appearance like a thin old person. Her ribs were very prominent
but her both legs were oedema.

Based on this information, Meri was likely to be classified in which condition below?
A. marasmus
B. kwashiorkor
C. marasmic-kwashiorkor
D. energy malnutrition
E. protein malnutrition

Key: C
5. Osti, a 2-year-old boy came to the outpatient clinic with chief complaint that he had
bow legs with O shape. Osti just moved to Jakarta a month ago. Before that, he lived in
Norway since he was born. According to his parents, Osti had a partial gastrectomy when
he was 1 year old due to a traffic accident.
Physical examination: Head: skull: flattening of the posterior skull
Teeth: none
Spine: mild scoliosis

Based on this information, what was the underlying problem that caused Osti’s
condition?
A. vitamin D deficiency
B. vitamin E deficiency
C. vitamin B deficiency
D. vitamin K deficiency
E. mineral Ca deficiency
Key: A

A 21 years old woman, a professional model, came to the outpatient clinic because she
had difficulties to concentrate, memory problem and also bad smell mouth odour. Since
the last month she reduced her food intake to lose some weight. She hardly ate and only
drank plain water or ate an apple when she was really hungry. She often had headache
and got faint easily. She also felt anxious and had sleep problem.

What was the underlying mechanism that caused the problems?


A. The energy source come mostly from carbohydrate
B. The energy source come mostly from protein
C. The energy source come mostly from fat
D. The energy source come mostly from water
E. The energy source come mostly from vitamin
Key: C

1. A 10 year old boy, was too hungry to chew his rice properly before swallowing. His
grandmother warned him, he was not going to get any energy from his food.
While his mother did not agree with his eating style she was of the opinion that he
would still benefit from his hastily swallowed food. What is the reason of his
grandmother opinion?

A Rice is a good source of fiber


B Amylose in rice is easily digested
C Saliva swallowed with rice contains amylase activity
D Pancreas excretes amylase and other digestive enzymes
E Intestinal glands excrete amylase more active than salivary amylase (D)

2. A 40 year old man has been treated with omeprazole for esophageal reflux.
While this inactivates a proton pump involved in the secretion of gastric acid,
chronic use may stimulate gastrin secretion. What is the consequence of continuous
gastrin secretion?

A Inhibition of pepsinogen secretion


B Inhibition of pepsinogen activation
C Inhibition of vitamin B12 absorption
D Stimulation of acid secretion into gastric lumen
E Stimulation of water secretion from mucosal wall (D)

3. Rina, a 20 year old student, had difficulty to concentrate while attending class because
of abdominal pain. They were very strong and continuous though not in a regular
way. She stays in a rented room and takes her meals when it is convenient to go out.
After visiting the student health center she found out that the pains were caused by

A Irregular menstrual cycle


B Spasms of the gastro-intestinal tract
C Decreased motility of the gastro-intestinal tract
D Excessive fluid secretion into gastric lumen
E Deficiency of pancreatic enzymes (B)

4. Fearing of overweight, Lila age 28, has for some time taken an inhibitor of α-amylase
obtained from red kidney beans. She was losing weight because of maldigestion.
What is the effect of the red kidney beans on extraction product on digestion
mechanism?
A insufficient Secretion of gastric juice
B insufficient Secretion of pancreatic juice
C insufficient Digestion of oligosaccharides
D insufficient Digestion of glycogen
E insufficient Hydrolysis of maltose
(C)

5. A 4 year old girl, brought to a clinic with chief complain diarrhea since this morning
after she had a glass of milk. Every time she had diary product she had diarrhea.
What substance may be deficient in this patient?
A Gastric protease
B Pancreatic amylase
C Lingual lipase
D Intestinal sucrase
E Intestinal lactase (E)

6. Pak Saman works as a street sweeper. One day he suffer from a disease, which caused
massive loss of fluid and electrolytes. He was taken
to a clinic and received intravenous administration of

A KCl D KCl and glucose


B HCl E NaCl and glucose
C Glucose (E)

7. After consulting a doctor and results of lab tests came out, Hadi was told that his
abdominal pain was caused by pancreatic insufficiency resulting in steatorrhea.
The lab test indicated an increase of

A Blood cholesterol D Urinary ketonebodies


B Blood bilirubin E Urinary glucose
C Fecal fat (C)

8. Sari drastically limited her salt intake for fear of hypertension. In doing so she
actually suppressed a cotransport mechanism in the intestinal wall which relies on
Na+ for the absorption of

A Monoacylglycerol D Glycerol
B Free fatty acid E Glucose
C Vitamin D (E)

9. At a ladies lunch gathering, Ibu Rina told her audience not to consider cholesterol
as absolutely harmful to the body and to be drastically avoided. She was actually.
referring to some of the benefits of cholesterol. Which of the following substance was
synthesized by cholesterol?

A Bile acids D Cholestyramine


B Bile pigments E Chylomicrons
C Cholecystokinin (A)

10. A 10 years old boy, suffering from starvation was taken to a clinic
for treatment. He still had good appetite but the doctor advised the nurse.
not to give him a high protein diet for a while. He is still in need of energy
from dietary carbohydrates. The reasoning of the doctor’s advise is

A Pepsin activity is still very low


B Trypsinogen is not yet sufficiently secreted
C Short peptides can easily penetrate intestinal mucosa
D Amino acid absorption is linked to active Na+, K+-pump
E Glucose is better absorbed in absence of intestinal peptides (D)

1. M, a 38-year-old businessman goes to see his doctor with complaints of watery,


foul-smelling diarrhea and flatulence for the past 3 weeks. He reports feeling
fatigued since his return from Kalimantan 2 months previously, and has suffered
abdominal cramping and intermittent loose, nonbloody stools since then.
Microscopic examination in stool specimen shows pear-shaped flagellated
trophozoites. Which one of the following organisms is the MOST likely cause?
A. Entamoeba coli
B. Entamoeba histolytica
C. Balantidium coli D
D.Giardia lamblia
E. Cryptosporidium parvum

2. Of the following, which one is the treatment of choice on the upper clinical case?
A. co-trimoxazole
B. ketoconazole
C. Metronidazole C
D. thiabendazole
E. Mebendazole

3. A 25 years old female comes to the clinic with chief complaint of diarrhea form
that 1 week duration. The diarrhea is watery with blood and mucous. Microscopic
examination shows protozoan with pseudopodia. Which of the following is the
most likely diagnosis?
A. minuta stage of Entamoeba histolytica
B. vegetative stage of Entamoeba histolytica
C. cystic stage of Entamoeba histolytica B
D. vegetative stage of Entamoeba coli
E. cystic stage of Entamoeba coli

4. Of the following, which one is the most likely mode by which this disease (upper
clinical case) as acguired?
A. ingestion of the larvae on the organism in contaminated food
B. ingestion of the egg on the organism in contaminated food
C. ingestion of the cystic on the organism in contaminated food C
D. drinking unboiled water supply
E. penetration of the skin by the organism while walking bare-footed

5. A 30 years old male works on pig farm. He presents with complaints of bloody
and mucous diarrhea of more than 2 months duration. Laboratory examination of
the stools show 60-70 micron cystic parasites with macronulei. Which of the
following is the most likely diagnosis?
A. Entamoeba coli
B. Entamoeba histolytica
C. Balantidium coli C
D.Giardia lamblia
E. Cryptosporidium parvum

6. A 24-years old man has been able to eat well for 2 weeks because of vomiting,
abdominal pain, and 3 months watery diarrhea, no blood or mucous. His
laboratory results show : HIV positive, and CD4 is 200/ul. Microscopic stool
examination with modified acid-fast (Kiyoun) stain shows 4 μm oocysts. Which
of the following is the most likely diagnosis?
A. Blastocystis hominis
B. Entamoeba histolytica
C. Balantidium coli E
D.Giardia lamblia
E. Cryptosporidium parvum

7. A 40-years old man goes to see his doctor with complaints of significant weight
loss, flatulence, and steatorrhoeic. He reports feeling fatigued 3 months previously,
and has suffered abdominal cramping. Which of the following is the initial
investigations should be made ?
A. An ELISA test
B. duodenal aspirate for microscopy
C. microscopic examination of stools C
D. X-ray films
E. CT-scan
1. While examining a tissue of the GI tract, you notice a stratified
squamous non-keratinizing epithelium lining the lumen, with a thick
muscularis mucosa layer beneath it.
Which of the following part of the GI tract are you examining?
A. Oral cavity
B. Esophagus
C. Stomach
D. Duodenum
E. Anal canal B

2. While examining a tissue of the GI tract, you notice a group of


mucous glands in the submucosa layer and many intestinal villi.
Which of the following part of the GI tract are you examining?
A. Duodenum
B. Jejunum
C. Ileum
D. Colon
E. Appendix A

3. While examining a tissue of the GI tract, you notice in the lamina


propria layer many straight, tubular, branched glands, consisting of
several kinds of cells. One kind of them are large, acidophilic cells.
Which of the following cells are you describing?
A. Stem cells
B. Mucous neck cells
C. Parietal cells
D. Chief (zymogenic) cells
E. Enteroendocrine cells C

4. While examining a tissue of the GI tract, you notice many lymphoid


nodules, surrounding a relative small lumen. No intestinal villi is seen.
Which of the following part of the GI tract are you examining?
A. Duodenum
B. Jejunum
C. Ileum
D. Colon
E. Appendix E

5. While examining a tissue of the GI tract, you notice many intestinal


villi. On one side of the wall you notice aggregates of lymphoid
nodules in the lamina propria and submucosa, opposite the
mesenterium.
Which of the following part of the GI tract are you examining?
A. Duodenum
B. Jejunum
C. Ileum
D. Colon
E. Appendix C

6. To optimize its absorptive function, the small intestines is differently


equipt than the large intestines.
Which of the following structures are found in the small intestines, but
not in the large intestines?
A. Crypts of Lieberkühn
B. Glands of Lieberkühn
C. Simple columnar epithelium
D. Intestinal villi
E. Auerbach plexus D

7. While examining a tissue of the GI tract, you notice a gradual


transition of the epithelial lining from stratified squamous epithelium
to simple columnar epithelium.
Which of the following part of the GI tract are you examining?
A. Transition from duodenum to jejunum
B. Transition from esophagus to gaster
C. Transition from gaster to duodenum
D. Transition from rectum to anus
E. Transition from ileum to colon D

8. The liver is an exocrine and endocrine gland. To fulfill its exocrine


function, what microscopic structure is seen in a microscopic section
of the liver?
A. Hepatic artery branch
B. Portal vein branch
C. Bile duct
D. Central vein
E. Portal triad C

9. Both hepatic lobule and liver acinus are found in the liver.
Which of the following feature is true for liver acinus, but not for
hepatic lobule?
A. Hexagonal
B. A structural unit
C. Involved in transporting of blood
D. 3 or 4 portal areas at its periphery
E. Involved in transporting of bile E

10.At the periphery of a hepatic lobule are several portal areas. A portal
area is the place where blood enter and bile leave the liver lobule.
Which of the following structure is not found in the portal area?
A. Hepatic artery branch
B. Portal vein branch
C. Bile duct
D. Central vein
E. Lymphatic vessel D

11.When viewing a liver section with high magnification, you notice a


thin slit between the hepatocytes and the endothelium of the sinusoids.
Which of the following name is correct for this slit?
A. Bile canaliculus
B. Bile ductule
C. Hering’s canal
D. Perisinusoidal canal
E. Space of Disse E

SOAL 1 DAN 2
A 17 year old male presented jaundice and dark yellow urine. He also complained of
nausea, low-grade fever, loss of appetite, and right hypochondrial pain. Of relevance in
his history was the fact that he had recently eat in a food stall with his friends, and his
friends also complained same symptoms . His physician sent a blood sample for analysis.
1. Which of the following serological profile has detectable in this patient?
a. Anti-HAV IgM
b. Anti-HBV IgM
c. Anti-HCV IgM
d. Anti-HDV IgM
e. Anti-HEV IgM

2. Which of the following modes of transmission is most likely to be implicated in this case?
a. Fecal-oral route
b. Blood-borne
c. Close contacts
d. Vector bite
e. Air-borne

SOAL 3 DAN 4
A 22 year old male had a history of having multiple sexual partners over the past year
presented with jaundice. He admitted because having pale stool and dark urine. Clinical
examination revealed a slightly enlarge liver with some right hypochondrial tenderness.
The serological profile was negative for IgG-HBs and positive for IgG-HBc, HBsAg.
3. Which of the following best describe his illness? Dr cucu
a. Early acute HBV infection
b. Chronic HBV infection
c. Window period
d. Vaccine-type response
e. Never infected

4. The patient had a girlfriend, who was seronegative. Which of the following preventing
measures could protect this girl?
a. Advice abstinence from sexual intercourse until he become asymptomatic
b. Give both a course of α-interferon
c. Administer hepatitis B immunoglobulin (HBIG)
d. Administer a single dose of HBIG and the HBV vaccine
e. Give both a course of ribavirin

A female tourist developed gastroenteritis while visiting small town in Indonesia and
tried some Indonesian traditional food. The onset of the disease is abrupt with
abdominal cramps and watery diarrhea. She had no fever or nausea or vomiting. The
symptoms have resolved within 24 hour and no subsequent recurrences. They report
the disease to district public health office. The investigation found that one of the food
products eaten by this tourist was contaminated by suspected pathogens.

1. Which food is the most likely source of this infection ?


a. Rendang
b. Gado-gado
c. Fried rice
d. Pepes
e. Coconut ice

2. What is the suspected pathogen may cause the disease above ?


a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E.coli
3. Regarding suspected pathogen mentioned No. 2, what statement below is
correct ?
a. Produce Shiga Toxin
b. Heavy fecal leukocytes found
c. Colon involved
d. Differentiated by Kaufmann-White scheme
e. Common nasal normal flora

Approximately 4 hour after eating a meal in restaurant, 2 members of a college student


group develop a sudden onset of nausea, vomiting, dizziness and severe abdominal
cramps. Nobody got febrile and only 1 had diarrhea. Within a day, the symptoms has
disappeared and no recurrences.

4. Which organism is most likely responsible for this outbreak ?


a. Salmonella typhi
b. Shigella dysenteriae
c. Enterohemorragic E. coli
d. Staphylococcus aureus
e. Enterotoxigenic E.coli

5. Which of the following is the most important specimen to be collected to confirm


diagnosis ?
a. Blood
b. Urine
c. Food
d. Fecal
e. Vomiting material

6. Which is correct statement about suspected agents above ?


a. Bacteria invade small bowel through M cells
b. Pathogen above evoke producing of B cell to produce immune system
response
c. Symptoms caused by toxin named Shiga-like toxin
d. Reheated in room temperature before cooked is a good steps in food
preparation
e. Inadequate cold storage before serving providing ideal conditions for
bacterial growth and enterotoxin production

A 36 years old woman came to private family doctor complaining fever for 7 days,
nausea, vomiting, anorexia and diarrhea.
Physical examination :
Temperature 39 °C, blood pressure 100/70 mmHg, pulse rate 80 per minute, respiratory
rate 20 per minute. She was moderately ill-appearing, dry and white mucous membrane
and tremor tongue, Hiperactive bowel abdominal sound and mild diffuse tenderness
Laboratory findings :
WBC count of 4500/mm3 , diff count 0/2/13/42/41/2
What organism may cause these symptomps above?
A. Shigella dysenteriae
B. Enteropathogenic E.coli
C. Salmonella enteritidis
D. Vibrio cholerae
E. Campylobacter

7. Microscopic of responsible pathogen’s Gram staining is :


a. Gram-negative rod
b. Gram-positive rod
c. Chain shape Gram-positive coccus
d. Cluster shape Gram-positive coccus
e. Coma shape Gram-negative

A 30 years old woman suffer with gastric pain and burning sensation all the time and
relieved by food and antacids. Family doctor ask her to get endoscopic examination and
found ulcer in the surface of gastric mucosa.

8. The pathogen that may cause the disease above is


a. Enteroaggregative E. Coli
b. Helicobacter pylori
c. Yersinia enterolitica
d. Campylobacter jejuni
e. Vibrio parahaemolyticus

9. The true statement below is


a. Pleimorphic shapea nd microaerophilic Gram negative rod
b. High concentration of urease product expressed allowing this pathogen
to generate ammonium ion that buffer gastric acid
c. May cause colon carcinoma by aplastic changing of colon mucosa
d. Urease breath test is a definitive test to identify the microorganism
e. Antibiotic treatment is not a mandatory in this case

Mrs.X, 42 years old, came to emergency department with a mild fever, followed by
malaise, fatigue, nausea and vomiting for 5 days. Acholic stool and darkening urine are
also appeared. Sclera and the skin looked yellow. The liver is palpable 2 cm below the
costal margin, tender and the spleen is enlarged. The patient was unconscious. No prior
history of the disease.
1. What is the mechanism of the darkening urine in the case above?
A. The unconjugated bilirubin filtered by the glomerulus
B. The red blood cells filtered by the glomerulus and appears in the urine
C. It is appears due to inflammation reaction in the renal
D. The unconjugated bilirubin is water soluble so it can appears in the urine
E. The conjugated bilirubin increase in plasma,readily filtered by the glomerulus

(E)

A 60 years old man, came to hospital with unconscious condition. From his relatives, we
knew that epigastric pain, nausea and heartburn were rare . Some medications
( Antacid etc ) had been taken but there was no improvement. He has taken aspirin for
his heart disease since 5 years ago. There was no hematemesis and no abnormality on the
physical findings. Endoscopic results showed some erosions and bleeding particularly in
the anthrum.

QUESTIONS

1. What is the most recommended treatment to prevent this disease?


A. Mucoprotector
B. H-2 receptor blocker
C. COX-2 specific inhibitors
D. Proton Pump Inhibitor
E. Prostaglandin analogue

(D)

2. What is the laboratory finding might show?


A. Increased platelet
B. Decreased hemoglobine
C. Decreased white blood count
D. Increased AST
E. Prolonged APTT

(B)

3. What substance synthesis is impaired in the case above?


A. Kinin
B. Pepsin
C. Glycoprotein
D. Gastrin
E. Prostaglandin
(E)

34 year old patient with dyspepsia and epigastric pain, was admitted to the polyclinic.
The lab test result was Hb 12 mg/dl, WBC 15.000/ul, Platelet 300.000. The doctor
suspected that the patient is suffering from acute gastritis. What further investigation will
help the doctor to confirm his definitive diagnosis?
a. Biopsy
b. Endoscopy
c. Culture of Biopsy tissue C
d. Culture of Gastric fluid
e. Blood culture

Which of the following organism is the etiology?


a. C. pylori
b. H. pylori
c. C. fetus B
d. C. jejuni
e. H. influenzae

Which of the following test is the non invasive for this case?
a. Biopsy
b. Detection of IgG
c. PCR B
d. Rapid urea test
e. Anatomical pathology test

A 20-month-old boy presents with a diarrhea since 3 days before admission. He is having
watery diarrhea for 3-5 times per day with blood and mucous; not malodorous, and are
not bulky or oily.
Physical examination: irritable and lethargic. BP 88/50 Pulse 110, RR 32, temp 38,6 OC.
He has sunken eyes and fontanel; decreased tears; dry mucous membranes; mild delay in
elasticity (skin turgor); and delayed capillary refill. His urine output is less than usual. He
is no apparent distress. His breath sounds are equal and clear. His abdomen is
nondistended with positive bowel sounds. There are no masses and no
hepatosplenomegaly. There are no perianal lesions.

- What is the most likely etiology of his diarrhea?


(A) Infection
(B) Drugs
(C) Allergy
(D) Malabsorption
(E) Vitamin deficiency

- What is your initial management for this patient?


(A) Oral rehydration solution 100-200mL every episode of diarrhea
(B) Isotonic IV solution 30 ml/kg/0,5 hours, then 70 ml/kg/2,5 hours
(C) Isotonic IV solution 100 ml/kg/3 hours
(D) Oral rehydration solution 75 ml/kg/3hrs
(E) Oral Rehydration ad libitum (as much as patient desired )

- The laboratory studies that would allow you to make the diagnosis include:
(A) stool for fat
(B) a stool culture
(C) stool examination for parasites
(D) a stool ELISA
(E) stool for reducing substance and pH

A 1-month-old baby presents with a diarrhea since 2 days before admission. He is having
watery diarrhea for 4-6 times per day with no blood no mucous; acid smell, and are not
bulky or oily. Her mother complained that her baby has rash around his buttock.
- What substance that is not properly absorbed in the case above?
(A) fats
(B) proteins
(C) carbohydrate
(D) vitamins
(E) minerals

- The antibiotic that most often leads to Clostridium difficile infection in pediatric
patients is:
(A) clindamycin
(B) amoxicillin
(C) erythromycin
(D) cefadroxil
(E) ciprofloxacin

A 60-year-old woman came to emergency room because of cramping abdominal pain,


vomiting, distended abdomen, and lack of defecation or flatus for the last 2 days.
Abdominal examination elicited abdominal distention and hyperactive of bowel sound.

1. What is the initial diagnostic test of the case above?


(A) colonoscopy
(B) abdominal CT-Scan
(C) gastroscopy E
(D) ultrasonography
(E) abdominal radiographs
2. The most likely diagnosis for the woman presented is :
(A) Pancreatic tumor
(B) Gastric carcinoma
(C) Perforated appendicitis D
(D) Colon tumor
(E) Rectal polyp

A 50-year-old man is admitted with massive bright red rectal bleeding. He recently had a
barium enema that demonstrated no diverticular or mass. Nasogastric suction reveals no
blood but does produce yellow bile. The patient continues to bleed.

3. What is the next diagnostic step?


(A) Repeat barium enema
(B) Colonoscopy B
(C) Upper gastrointestinal series
(D) Mesenteric angiography
(E) Small bowel follow-through with barium
4. The most likely cause of the bleeding is?
(A) Internal hemorrhoid
(B) Regional enteritis
(C) Duodenal ulcer E
(D) Intussuception
(E) Angiodysplasia

A 22-year-old man whose father and older brother died of colon cancer is evaluated for
painless rectal bleeding. A flexible sigmoidoscopy reveals the presence of multiple polyps
throughout the sigmoid colon, with sparing of the rectum.

5. What is the next procedure to be performed?


(A) Repeat sigmoidoscopy and biopsy
(B) Barium enema
(C) Radionuclide imaging D
(D) Colonoscopy and biopsy
(E) Selective arteriography
6. The most likely diagnosis for the man presented is :
(A) Villous adenomas
(B) Zollinger-Ellison syndrome C
(C) Familial adenomatous polyposis
(D) Colon cancer
(E) Hamartomatous polyps

JAWABAN : E, D, B, E, D, C, D, B, D, C, A, A, E,
A 8-year-old girl presents in the emergency department with a 24-hour history of
increasingly severe right lower quadrant abdominal pain. The pain began in the
periumbilical region, which was associated with nausea and vomiting. On physical
examination, she has tenderness in the right lower quadrant with rebound, and there is no
mass. On rectal examination also reveals right-sided tenderness. Low grade fever and
mild leukocytosis are present.

7. The most accurate diagnostic test of the case is :


(A) Barium enema
(B) Upper gastrointestinal series
(C) Ultrasonography D
(D) CT scan abdomen with contrast
(E) Flat and upright abdominal radiographs

8. What is the most likely diagnosis?


(A) Acute diverticulitis
(B) Acute appendicitis B
(C) Ureteral stone
(D) pyelonephritis
(E) Intussusception

9. The initial management for this patient should be


(A) Broad-spectrum antibiotic therapy
(B) Analgesics
(C) Observation
(D) Fasting and prepare for surgery
(E) Diagnostic laparoscopy

JAWABAN : E, D, B, E, D, C, D, B, D, C, A, A, E,

10. The definitive therapy should be


(A) Laparotomy
(B) Drainage
(C) Appendectomy
(D) Ureterolithotomy
(E) Diverticular resection

JAWABAN : E, D, B, E, D, C, D, B, D, C, A, A, E,
A 45-year-old man presents in the emergency room with a history of acute onset of severe
epigastric pain radiating toward the back. The pain began several hours after consuming
fatty meal. The patient has no significant medical history and denies any previous
surgery. On physical examination, the patient has marked epigastric tenderness with
guarding and hypoactive bowel sounds. The patient’s amylase level is 2500 units.

11. What is the most likely cause of this patient’s pain?


(A) Gallstones
(B) GERD
(C) Duodenal ulcer A
(D) Nephrolithiasis
(E) Peptic ulcer
12. Initial treatment for this patient should be :
(A) Nothing by mouth, insertion a nasogastric tube, fluid resuscitation, insertion
of a Foley catheter and antibiotics
(B) Bile duct exploration
(C) Endoscopic retrograde cholangiopancreatography (ERCP)
(D) Emergency cholecystectomy and intraoperative cholangiogram
(E) Pancreatic debridement and drainage

13. What is the possible origin for referred pain to right shoulder
(A) Kidney
(B) Ureter
(C) Pancreas
(D) Duodenum
(E) Gallbladder
14. What is the possible diagnosis of left lower quadrant abdominal pain
(A) Gastritis
(B) Pancreatitis
(C) Herpes zoster
(D) Diverticulitis
(E) Perforated ulcer

70.A 45- year old man was admitted to the emergency department complaining of severe
pain in the right lower quadrant of the anterior abdominal wall. He had repeatedly
vomited, and his temperature and pulse rate were elevated. On examination, the
muscles of the lower part of the anterior abdominal wall in the right lower quadrant
showed tenderness at the MC Burney point. You are at surgery for removal, but the
organ is not visible.
What position of this organ is likely to be?
A. Paracecal
B. Paracolic
C. Retrocecal C

D. Iliocecal
E. Retrocolic

72.A surgery procedure was performed and you encounter an artery and vein in the
superficial fascia of the lower abdominal wall.
Which vessel are most likely the superficial of the lower abdominal wall?
A. Superficial epigastria artery
B. Circumflex iliac artery
C. External iliac artery
A
D. Superior epigastria artery
E. Inferior epigastria artery

73.During surgery, you must incise the anterior rectus sheath between the xiphoid process
and the umbilicus.
In this region, which of the following muscle derives the rectus sheath?

A. External abdominal oblique only


B. Internal abdominal oblique only
C. External and Internal abdominal oblique C
D. Internal oblique and transverses abdominal
E. Transversus abdominal only

74.A 42-year old male has a 6 months history of epigastric pain and is constant in nature
especially after meals. His passed tarry stool (black stool) over the previous 2 moths.
Laboratory of stool’s test showed occult blood.
What organ is the most likely to be affected?
A. jejunum
B. gaster
C. ileum B
D. appendix
E. gallbladder

75.A 45-year-old obese woman complaining of indigestion was admitted to hospital for
investigation. She had past history of gallstone and transient attack of jaundice. Large
gallstone have been known to erode through the posterior wall of the gallbladder and
enter the intestinal tract
Which part of the intestinal tract is likely to initially contain the stone?
A. Sigmoid colon
B. Descending colon
C. Transverse colon C
D. Ascending colon
E. Jejunum
76.A 55 year old man with a long history of duodenal ulcer was seen in emergency room
after vomiting blood and exhibiting severe hypovolemic shock. Assuming the ulcer
had perforated the posterior wall of the first part of duodenum, which artery is most
likely to have been eroded?
A. Splenic artery
B. Right gastric artery
C. Gastroduodenal artery C
D. Right gastroepiploica artery
E. Proper Hepatic artery

55. Bonda 11 months old boy. He was well until four months ago when his mother stopped
breast-feeding and began giving him cow’s milk with other food. Since then Bondan has had
two episodes of diarrhea, the current one having begun three days ago. Bondan still takes
cow’s milk but his mother has reduced his intake of solid food since the diarrhea begun.
There has been no blood in the stool. Bondan weighs 8 kg. What should you do in this case ?
A. Give Bondan antibiotic for possible infection
B. Prescribe a special lactose-free formula and have the mother give this in place of the
cow’s milk.
C. Tell the mother to give Bondan sweetened fruit drinks or tea, whichs he likes, so that he
receives enough fluid
D
D. Advise the mother to dilute Bondan’s milk with an equal amount of water, oral
rehydration solution and to increase other energy-rich foods in his diet, if not improved
he should be referred to hospital
E. Tell the mother to take Bondan to a hospital right away

56. A 50 year old man was healthy until he developed vomitting five days ago. He said that he
did not eat as much as usual. He was feeling amount of food in his epigastric area since one
month ago. He had history of rheumatoid arthritis. Mrs. RANI was go to the hospital, and get
some medication. Which of the following factors is not correlate to the incidence and severity
of the symptom?
A. Chili and sour food
B. Usually becoming late in breakfast time
C. Drink black coffee and tea in the morning
C
D. Using NSAID for long time
E. Helycobacter pylori infection

57. Kurmin, a 10 year old boy, bring by her mother to policinic because he had fever and
jaundice for five days. He also suffered for vomiting for about 5 times per day. When the
doctor examine him, the doctor note that he is lethargic, his eyes are yellow, she has
hepatomegalyi. Kurmin appear to be undernourished. Based on these findings, what
conclusions would you draw about Kurmin’s condition, which one is not correct ?
A. HAV is transmitted commonly most via the fecal-oral route. Epidemics of HAV infection
may be explained by person-to-person contact, such as occurs at institutions, or by
exposure to a common source, such as consumption of contaminated water or food.
B. The incubation period of HAV is 15-45 days (average 4 wk). The virus is excreted in stool
during the first few weeks of infection, prior to the onset of symptoms. Acute hepatitis A
is more severe and has higher mortality in adults than in children.
E
C. Typical cases of acute HAV infection are marked by several weeks of malaise, anorexia,
nausea, vomiting, and elevated aminotransferase levels. Jaundice develops in more severe
cases.
D. Acute infection is documented by the presence of immunoglobulin M (IgM) anti-HAV,
which disappears several months after the initial infection.
E. Hospitalization is needed for all patients of hepatitis A.

58. LENA, aged 3 years old, is brought to the Puskesmas because of bloody defecation, which
began three days ago. At first the stools were only loose, but yesterday his mother saw blood
in them. The mother believes LENA has no fever. Which of the following statement must ask
to confirm gastrointestinal bleeding in children?
A. Anorectal disorders, fissures, and distal polyps produce bright red blood
B. Melena rather than bright red blood per rectum is usually a sign of bleeding that comes
from a source proximal to the ligament of Treitz.
C. Massive upper GI bleeding, however, can produce bright red blood per rectum if GI transit
time is rapid.
E
D. Familial history or nonsteroidal anti-inflammatory drug (NSAID) use may suggest ulcer
disease. Ingested substances, such as NSAIDs, steroids, and foreign bodies, can irritate
the gastric mucosa enough to cause blood to be mixed with the vomitus.
E. Recent jaundice, easy bruising, and changes in stool color may not important signal for GI
bleeding in liver disease.

59. Five year old boy with right lower abdominal pain, has been brought to the Hospital by her
mother. He has been assessed and found to have some signs of appendicitis. What is not
appropriate statement about this case?
A. Appendicitis is the most common surgical emergency of children
B. Duration of symptoms is associated with ruptured (perforation), and delay of surgical
treatment
C. Delay in surgical definitive management, increase the risk of perforation and hospital
length of stay.
E
D. Young children had the lowest incidence of acute appendicitis, but greater risk of
complication than teenage.
E. The small children can communicate their symptoms as well as adult.

60. You are assessing a patient with ascites by having the patient assume the knee chest
position. After a few minute, you do percussion on the umbilical area. This technique
for assessing ascites is called:
A. Shifting dullness
B. Fluid wave
C. Puddle sign C
D. Cullen’s sign
E. Psoas sign

61. Rota is 9 months old and was healthy until he developed diarrhea a half weeks ago. The
episode began with stools that were loose and sometimes watery. The frequency of diarrhea
was about three times/day. Each time of diarrhea is about a half aqua cup. During the last few
days Rota’s mother has noted “acid smell” in his stool. Rota has vomited several times in the
past days.
A. Allergic diarrhea
B. Acute dysentery
C. Acute diarrhea
C
D. Chronic diarrhea
E. Persistent diarrhea with blood

62. Rota is 6 months old and was healthy until he developed diarrhea two days ago.
Rota’s mother says that he does not eat as much as usual. He was weaned from breast
milk to cow’s milk at age of 3 months. Rota’s immunization is complete. Rota was
bring to the Puskesmas and get Oralit. Which of the following factors is not correlate
to the incidence and severity of diarrhea in young children ?
A. Washing hands after defecation and before preparing food
B. Exclusive breast feeding for the first 4-6 months of life
C. Bathing the child frequently
C
D. Using infant bottles
E. Immunization against measles

63. Lakto, a 1 year old boy, bring by her mother to emergency room because he had
diarrhea for five days. The frequency was 10 times per day. Each time was about a
half aqua cup. He also suffered for vomiting for about 5 times per day. When the
doctor examine him, the doctor note that he is lethargic, his eyes are sunken, she has
no tears when she cries, his mouth is dry, and he didn’t drink eagerly. His skin pinch
goes back slowly (more than 2 seconds). Lacto appear to be undernourished. Based
on these findings, what conclusions would you draw about Lacto’s condition and how
she should be treated ?
A. Lakto has some dehydration and should be treated according to treatment plan A
B. Lakto has severe dehydration and should be treated according to treatment plan B
C. Lakto has severe dehydration and should be given by the intra venous fluid
C
D. Lakto has some dehydration and should be treated by giving infussion
E. Lakto has some dehydration and should be treated by giving oral rehydration
solution

64. Lakto, aged 13 months, is brought to the Puskesmas because of diarrhea, which began
three days ago. At first the stools were only loose, but yesterday his mother saw blood
in them and smelly. The mother believes Lakto has a fever. He has also vomited three
time per day. When you examine Lakto, you note that he is alert, irritable and
restless. His eyes are not sunken, he has tears when he cries, his mouth is moist, he
will drink some water. His skin goes back quickly. His temperature is 38 C. Which of
the following statement is correct?
A. Lakto has some dehydration and should be treated according to treatment plan
B
B. Lakto has some dehydration and should be infused
C. Lakto has no signs of dehydration, give the oral rehydration solution and
should be treated for dysentery
C
D. Lakto has no signs of dehydration and just give the oral rehydration solution
E. Lakto has some dehydration and should be treated for dysentery

65. A mother has brought her 2 years old daughter, Rena to the Puskesmas. Rena has been
assessed and found to have some signs of dehydration. She weighs 10 kg. While at
the Puskesmas, her mother has given her 600 ml of Renalit/ORS solution within 3
hours. After 4 hours, Rena still has some signs of dehydration, but is improving.
Assuming that the mother can stay at the Puskesmas, what shoul be done next?
A. Stop the Renalit and give 500 ml KAEN3B solution intravenously during the
next 3 hours
B. Repeat plan B, giving 750 ml of Renalit in the next 4 hours and start to feed
the child as described in plan A.
B
C. Pass an nasogastric tube and give 1000 mL ORS solution by the NGT in the
next 4 hours
D. Suggest the mother that Rena can go home
E. Give the mother the antibiotic for diarrhea

66. Rena, 1n 16 month old baby with diarrhea, has been brought to the Puskesmas by his
grandmother. She weighs 10 kg. She has been assessed and found to have some signs
of dehydration. The grandmother must leave soon to catch the last bus, it is too far for
her to walk home. What is the unappropriate suggestions?
A. Give the grandmother 750 ml of ORS solution and show her how to give it to
Rena during the next 4 hours.
B. Explain to the grandmother how Rena should be fed when they return home
C. Give the grandmother packets of ORS for use in treating Rena at home during
the next 2 days, after he has been rehydrated
D
D. Give the child an antibiotic to treat his infection
E. Explain to the grandmother when she must go back to the Puskesmas by
assessing Rena’s condition

67. A 38 years old man comes to the emergency with fatigue and abdominal swelling. For
several months he has noticed that his abdomen has becam larger and his skin turned
in yellow. On examination, his palm shows redness, his abdomen is markedly
distended and a fluid wave is present.
What organ is likely to be affected?
A. Gall bladder
B. Pancreas
C. Liver C
D. Portal vein
E. Stomach

68. A 44 year old man complains of discomfort in his right upper thigh over the
past 6 months. He works in the garden department of a home improvement centre. On
physical examination, there is a bulge at the right inguinal area that is not reducible.
What is the most likely diagnosis?
A. Femoral Hernia
B. Lymphadentis inguinalis
C. Congenital Inguinal Hernia
D
D. Acquired Inguinal Hernia
E. Incarcerated Hernia

Soal 4-7
Today, Adi a student of Faculty of Medicine Universitas Pelita Harapan, want to go to his
classmate Ani. Ani said that her mother has jaundice. So she call Adi to have suggestion
about her mother.
According to Ani, several week ago his mother suffered abdominal colic for several days.
Now the colic is not come again, but since two days ago, her mother got jundice. So, Adi
think about what happened to Ani’s mother. He suggest Ani to make a laboratory test for
her mother, to know what kind of substance that may increase its concentration.
4. Adi think that Ani’s mother jaundice is caused by:
A. Hepatitis
B. hepatic cirrhosis
C. portal obstruction
E
D. hemolytic disease
E. bile duct obstruction

5. Substance that may increase in concentration is:


A. globulin
B. albumin
C. free bilirubin
E
D. cholecystokinin
E. conjugated bilirubin

6. Ani’s mother stool may indicate:


A. normal
B. melena
C. diarrhea
D
D. very fatty
E. very hard
7. The substance that may responsible to the golden yellow colour of bile is:
A. albumin
B. globulin
C. cholecystokinin
E
D. alkaline phosphatase
E. bilirubin and biliverdin

Soal 8-10
Before going back to his dormitory, Adi goes to Cafe Murah to have lunch. During
waiting for his meal, he sits in a table. Suddenly, he smell something very attractive
flavor, so his saliva is coming out from his saliva glands.

8. The digestive enzyme that we may can find in Adi’s saliva is:
A. maltase
B. protease
C. peptidase
D
D. -amylase
E. none of the above.

9. The pH of Adi’s saliva in his condition now is about:


A. 4
B. 6
C. 8
C
D. 10
E. 12

10. The conditioned stimulus that may stimulate the secretion of Adi’s saliva is:
A. food in the mouth
B. seeing a tasty food
C. thinking a tasty food
D
D. smelling a tasty food
E. sitting on the restaurant table to wait a meal

Soal 11-12
A 17 year old healthy boy is having breakfast. He masticate the food slowly, to give
attention to his food in his mouth. He feels that the saliva is still coming out from the
saliva’s glands, and make mastication is going more gentle, the taste of the food more
tasty. Then he swallow the bolus. He can manage the action of swallowing.
11. What is the first reflex in swallowing food?
A. glottic closure
B. inhibition of respiration
C. relaxation of lower esophageal sphincter E
D. contraction of esophageal muscles
E. contraction of pharyngeal muscles

12. What Reflex allow the food to enter the stomach?


A. glottic closure
B. inhibition of respiration
C. relaxation of lower esophageal sphincter
C
D. contraction of esophageal muscles
E. contraction of pharyngeal muscles

A. glottic closure
B. inhibition of respiration
C. relaxation of lower esophageal sphincter (LES)
C
D. peristaltic ring contraction of esophageal muscles
E. contraction of pharyngeal muscles that pushes bolus into the
esophagus

Soal 13-14
Adi think about the regulation of the GI tract function. It must be exist some systems that
may regulate the function of the GI tract, so we need not worry and to think about it.
According to the anatomy lessons, there are some plexuses and nervous systems that
regulate the function of GI tract systems so that they can work automatically and
independent to our mind. Adi remember that one of the system is called the enteric
nervous system.
13. Which one is constituted what Adi remember:
A. hypogastric plexus
B. sympathetic nervous system
C. parasympathetic nervous system
D
D. the myenteric and submucous plexus
E. the preganglionic fibers of sympathetic nervous system

14. Adi also remember that the enteric nervous system is concerned with the function of:
A. deglutition
B. defecation
C. hepatic portal system
E
D. viscerosensory system
E. motility and secretion of the intestines

A 15 year old boy is having a cup of coffee for the first time. After 30 minutes, he feel
nausea and then vomiting. During vomiting, he feels the muscles of his abdominal wall
contract forcefully and then the content of his stomach is push back to his mouth and to
the outside. He thinks that between stomach and the mouth during normal conditions
there must be something that prevent the content of the stomach to flow back to the
mouth.
15. Which organ plays an important role in the prevention of gastric reflux?
A. glottis
B. diaphragm
C. sphincter pylorus
D
D. lower esophageal sphincter
E. peristaltic ring contraction of esophageal muscles

16. In the normal condition, during what condition it relaxes?


A. resting
B. coughing
C. expiration
E
B. inspiration
C. swallowing

Soal 17
It is 13:00 o’clock in the afternoon. Adi feel a mild pain in the epigastric region as usual
if he does not take a meal in this time. Since 7:00 in the morning, he does not eat
something.
17. What is the cause of mild pain?
A. angina
B. bile colic
C. muscle cramp
E
D. duodenal colic
E. hunger contraction

GASTROINTESTINAL BLOCK
PEMBUAT SOAL: dr. DARWIN FERDINAN SALIM

1. A 60-year-old male, come to the Siloam Hospital with a chief complain of


bloody vomiting. The blood was red and fresh. The patient also tells that
his stool was dark. At physical examination, there are palmar eritema,
spider neavi, and ascites at the abdomen.
Where do you think is the blood came from?

a. Rupture of Esophageal veins


b. Gastric perforation
c. Rupture of Mesentrica Superior veins
d. Rupture of Mesentrica Inferior veins
e. Rupture of Superior cava vein

Answer : A

2.
A 60-year-old male, come to the Siloam Hospital with a chief complain of
bloody vomiting. The blood was red and fresh. The patient also tells that his
stool was dark. At physical examination, there are palmar eritema, spider
neavi, and ascites at the abdomen. The USG show a nodul on the right lobule
of the hepar. Which of the following test that can help you diagnose?
a. CA 19-9
b. -feto protein
c. PSA
d. CA-153
e. Seromoeba

Answer : B

3. A 46-year-old Female, come to the clinic, with a chief complain of severe


pain in the upper right abdomen. the pain is not show up all the time, and
it is spreading to the upper middle abdomen. the patient also complains of
nausea, vomiting and fever. On the physical examination, her weight is
80kgs, height 160cm, on the abdomen, Murphy’s sign +.
What is the most likely diagnosis?
a. Perforating of gastric ulcers
b. Acute Pancreatitis
c. Gastroduodentitis
d. Acute Cholesistitis
e. Acute Pyelonefritis

Answer : D

4. A 40-year-old male traveler from Germany, come to the hospital with a


chief complain of diarrhea, 10 times per day since last night. His stool was
yellow without any blood or mucus. He said that he had a glass of cendol
in the morning and at night he gets diarrhea. On the physical
examination, the mental status compos mentis, BP: 110/80 mmHg, Pulse:
84x/min, temp: 37,5C.
What do you think that caused this patient diarrhea?

a. Salmonella
b. E. Coli
c. Virus Norwalk
d. Shigella
e. Amoeba

Answer : B

5. A mother bring her 3-month-old baby to the hospital with a chief


complain of diarrhea 6 times a day, since 2 days ago. She also tells that
her baby was vomiting, and became irritable. She also tells that she gave
her baby powder cow milk (2 table spoon with 30cc of water) for 3 days,
before the baby get diarrhea. On the physical examination, the baby
weight is 7 kg, Temp : 36.4 OC, pulse: 110x/min, irritable, crying with
small amount of tears, skin turgor slightly decrease.
What is the type of diarrhea that the baby suffer?
a. Secretoric diarrhea
b. Traveller’s diarrhea
c. Exudative diarrhea
d. Osmotic diarrhea
e. Food poisoning diarrhea

Answer : D

1. As a surgeon performing appendectomy, you encounter an appendicular


artery
Which vessel is directly giving branch to the appedicular artery?
A. ileocolica artery
B. colica sinistra artery A
C. jejunal artery
D. ileal artery
E. colica dextra artery

2. What is the origin of the vessel above?


A. mesenterica inferior a.
B. mesenterica superior a.
C. coeliaca a. B
D. superior rectalis a.
E. middle colic a

3. During surgery, you must incise the anterior rectus sheath between the
xiphoid process and the umbilicus.
In this region, which muscle derives the rectus sheath?
F. External abdominal oblique only
G. Internal abdominal oblique only
H. External and Internal abdominal oblique C
I. Internal oblique and transverses abdominis
J. Transversus abdominis only
4. A 44 year old man complains of discomfort in his right upper thigh over the
past 6 months. He works in the garden department of a home improvement
centre. On physical examination, there is a bulge above inguinal ligament
located medial to inferior epigastirc artery.
What is the most likely diagnosis?
A. Femoral Hernia
B. Lymphadentis inguinalis
C. Direct Inguinal Hernia D
D. Indirect Inguinal Hernia
E. Inguinal Lipoma

5. A 55 year old woman has a bulge in the groin since 3 months ago. She is an
over weight woman with 100 kg BW. She was diagnosed with femoral hernia.
Where is the location of femoral hernia is:
A. above inguinal ligament medial to hypogastric artery C
B. above inguinal ligament lateral to hypogastric artery
C. below inguinal ligament in femoral triangle
D. below inguinal ligament in inguinal triangle

6. You are examining the liver during a surgical procedure. The inferior caval
vein is located in between which of two anatomical lobes?
a. Quadrate and caudate lobes
b. Caudate and left lobes E
c. Right and quadrate lobes
d. Left and quadrate lobes
e. Right and caudate lobes

7. Esophagus, stomach, duodenum, jejunum, ileum and colon are


derivatives of GIT. All of them differentiate from ……………
a. foregut, midgut and hindgut
b. only foregut and midgut
c. only midgut and hindgut A
d. primitive gut
e. endoderm

8. There are two pancreatic duct bring the enzymes produced by pancreas.
To what structure the enzyme is drained?
A. Stomach
B. Duodenum pars superior
C. Duodenum pars descenden C
D. Jejunum
E. Ileum
9. A 25 year old man with typhoid fever and acute abdominal pain. The
surgeon is examining the small intestine during a surgical procedure. As a
clerk in the surgery department, you have to know the difference between
jejunum and ileum
What is the most alteration between jejunum and ileum?
a. Diameter jejunum smaller than ileum
b. The wall of jejunum thicker than ileum
c. Vascularity of jejunum less than ileum B
d. Color of jejunum pale that ileum
e. Plica circularis of jejunum shorter than ileum

10. A 69 year old man with abdominal mass underwent laparatomy. You are
examining the large intestine during the surgical procedure. To avoid
cutting the vessel, you must know the topography of the intestine.
What structure is supplied by the inferior mesenteric?
a. Colon descenden
b. Caudate ascenden A
c. Colon transversum
d. Jejunum
e. Ileum